MEDICARE: PREFERRED RX, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	49091	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	49091	OTHER	CA	CALIFORNIA BOARD OF PHARMACY PERMIT NUMBER

General Provider Information

NPI Number	:	1790945343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED RX, INC.

Provider Business Mailing Address
First Line	:	3560 S LA CIENEGA BLVD STE B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-4400
Country	:	US
Telephone Number	:	323-939-3900
Fax Number	:	323-939-3909

Provider Business Practice Location Address
First Line	:	3560 S LA CIENEGA BLVD STE B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-4400
Country	:	US
Telephone Number	:	323-939-3900
Fax Number	:	323-939-3909

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VADIM GURMAN
Credential	:
Telephone Number	:	323-459-0785

Provider Enumeration Date	:	06/16/2008
Last Update Date	:	01/07/2011

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Directions to “PREFERRED RX, INC. ” Practice Location

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